Not The Most Diligent

Okay, I may or may not have been a wildly ineffectively blogger for the past few weeks.

I understand this. Let's all just move past it.

We left off at the beginning of the Cardiopulmonary module. The first half the module, Cardio, is now over and I'm pleased to report it was a rousing success. While I now know more than I ever wanted to about the electrophysiology of the heart, it has been interesting and a good module. We've learned much more doctor-ly things such as how to read ECGs (there actually is information in those squiggly lines) and listen to the various heart sounds (<--INTERACTIVE!). To me, learning about heart defects has been one of the more interesting subjects. While I won't go into big hairy details, one aspect is too cool not to share. In general, I think we can all agree that having a heart defect would be an unfortunate thing. That is, unless you've got more than one defect. Sometimes, having a heart defect can actually save your life. More on that later, but first, a bit of background to fully appreciate what's going on here.

Your heart is made up of four chambers (atria and ventricles), separated by four valves, and can be divided into left and right halves. The ventricles are the lower chambers of the heart and are the real workhorses. The atria (plural for atrium) function to kind of "prime" the ventricles and keep the blood flowing.

Blood that has been in your body (deoxygenated) flows into the right atrium. From here it passes through the tricuspid valve and into the right ventricle. The right ventricle pumps blood through the pulmonic valve and into the pulmonary artery where it goes to the lungs to gain oxygen. Once the blood has oxygen, it flows from the lungs and into the left atrium. From here, the blood passes through the mitral valve (named for a bishop's mitre) and into the left ventricle. The left ventricle pumps blood through the aortic valve and into your aorta where it goes to your entire body and provides that much needed oxygen.

Having a hole in your heart that changes this flow of oxygenated/deoxygenated blood constitutes a fairly large number of heart defects and many of them either close on their own or can be fixed. (In fact, when you're growing in the womb, it's normal and necessary to have one so your blood bypasses the lungs.) But I digress.

One major heart problem is called Transposition of the Great Vessels (technically dextro-TotGV, but we're simplifying here). Because of a problem during development, a person's pulmonary artery and aorta are switched. Aside from this sounding scary (which it is), it prevents blood from undergoing its normal exchange of oxygen. Oxygen-rich blood simply cycles from the lungs, through the left side of the heart, and back into the lungs. Oxygen-depleted blood from the body enters the right side of the heart and is pumped into the aorta and back in to the body. Having this defect on its own is, as they say in school, "incompatible with life." (How's that for cold medical talk, eh?)

"Bad News"---^

Now you may be asking yourself (if you're still reading), Okay, Matthew, where does the coolness of this all come in? Cause right now, you're just talking about fatal heart defects.

I understand, dear reader(s). The cool part about this is that if a person has transposition of the great vessels AND another hole-in-the-heart defect (such as Patent Ductus Arteriosus or Atrial Septal Defect), the second defect allows just enough oxygen to intermingle and flow what is normally the wrong way that the person stays alive. When this dual defect is coupled with the (hopefully) astute actions of the medical team delivering the baby, the doctors are able to recognize what's going on, rush the baby into surgery and swap the vessels around to where they are supposed to be.

That's right, crazy-emergency-heart-surgery-on-a-baby-that-has-a-success-rate-of-OVER 90%. Medicine FTW! (FTW= For the Win)

Until next time. (Which will be much sooner- I know, I know.)

Quite Interesting

While I shy away from directly copying direct work (and instead prefer to link), I repost this from another (who was herself doing so), because I think it's quite interesting and raises some good questions.

Washington, DC Metro Station on a cold January morning in 2007. The man with a violin played six Bach pieces for about 45 minutes. During that time approximately. 2 thousand people went through the station, most of them on their way to work. After 3 minutes a middle aged man noticed there was a musician playing. He slowed his pace and stopped for a few seconds and then hurried to meet his schedule.

4 minutes later:

The violinist received his first dollar: a woman threw the money in the hat and, without stopping, continued to walk.

6 minutes:

A young man leaned against the wall to listen to him, then looked at his watch and started to walk again.

10 minutes:

A 3-year old boy stopped but his mother tugged him along hurriedly. The kid stopped to look at the violinist again, but the mother pushed hard and the child continued to walk, turning his head all the time. This action was repeated by several other children. Every parent, without exception, forced their children to move on quickly.

45 minutes:

The musician played continuously. Only 6 people stopped and listened for a short while. About 20 gave money but continued to walk at their normal pace. The man collected a total of $32.

1 hour:

He finished playing and silence took over. No one noticed. No one applauded, nor was there any recognition.

No one knew this, but the violinist was Joshua Bell, one of the greatest musicians in the world. He played one of the most intricate pieces ever written, with a violin worth $3.5 million dollars. Two days before Joshua Bell sold out a theater in Boston where the seats averaged $100.

This is a true story. Joshua Bell playing incognito in the metro station was organized by the Washington Post as part of a social experiment about perception, taste and people’s priorities.

The questions raised:

*In a common place environment at an inappropriate hour, do we perceive beauty?

*Do we stop to appreciate it?

*Do we recognize talent in an unexpected context?

One possible conclusion reached from this experiment could be this:

If we do not have a moment to stop and listen to one of the best musicians in the world, playing some of the finest music ever written, with one of the most beautiful instruments ever made.

How many other things are we missing?

The source article from the Post can be found here and is worth a read. It includes a video.

Until next time.

The Heart of It All

I can assure you all that a giant sigh of relief and a weekend of nothing medical followed my completion of I2. Now that Inflammation and Immunity is slowly rotting, dead in the cold cold ground, we're moving on to a more meat-and-potatoes-esque med school module.

CardioPulm.

That's right, after 8 weeks of straight science, 4 weeks of genetics and cancer, and 4 weeks of I2, or as I like to call it: 16-weeks-of-occasionally-interesting-but-typically-dreadful-information-on-tiny-molecular/cellular-changes-in-your body (it rolls off the tongue), we're finally digging into an 8 weeks module that will be tiny molecular/cellular changes sprinkled with gross anatomy!

The holiday season splits this module right down the middle, with cardiology falling sooner and pulmonary falling later. The truly exciting part? (Note: I say exciting now and reserve the right to change it to ridiculous once we begin) We start cadaver lab when we get back in January! Woo!

So, in honor of our new module, I shall post one of the many slides we were told to memorize today. Get pumped!



Hah! Get it? Pumped...
Until next time.

Real Med School

That is how our current module, I2, was described to all of us, the wee-little first years, by a few of the M2s. Sadly, three weeks into the module (with the test looming on this coming Wednesday) it seems they are correct. Evidence of this? My lack of blog posts. Inflammation and Immunity, while great for a person's well-being, seems to be decidedly bad for any free time I might have had this month.

That being said, what have I been doing for the past half an hour?

Not I2.

After finishing my review of this morning's lecture and review (that's right, a review...of...a...review...) I felt like a break was in order before a student panel here in a few minutes. As some of you may or may not know, I have one blood sibling, an older sister, who also writes a blog. Now, while she is a great sister, loving mom, and probably caring wife, she also exploits her children for blog-hits. I thought, If she uses my nephews, why can't I?

So! Behold! I present photos that my sister took in an attempt to capture the spirit of her children. Sadly, where she fails, I succeed. She captured their expressions; I have revealed their true thoughts.

*Note*: As my sister was the photographer, the thoughts of the subjects naturally reference her.

Series 1!

Series 2!




This is all. I must study. Again.

Until next time.

A Unique Look

As GenNeo wraps up, I feel like I should make some kind of post that shows it actually even happened (other than Things I Like More Than GenNeo). While we have learned a lot of interesting things (and believe me, some things that were just not interesting at all), what I'm about to post really stuck with me as an interesting representation of just how much cancer can flat out screw your body up.

The typical person's genetic makeup consists of two copies of 23 chromosomes (one from each parent). Mishaps can occur on a large scale such as Down Syndrome (or Trisomy 21), where a person has an extra chromosome, or on a very small scale such as Sickle Cell Disease, where a single piece of your DNA (a nucleotide- the ATCGs) is inserted wrong (this is called a point mutation).

A karyotype provides a quick way to look at a person's genes to see big large-scale changes. It's really just a picture of each chromosome from a person's cell lined up in their respective pairs. A karyotype looks like this:
The chromosomes look very similar and seem pretty neat and orderly. If examined, we can see that this person was a male, we'll call him Clark, because there is a single X chromosome with a Y chromosome (a woman would have two X chromosomes). Clark inveitably has mutations. We all have tons of them that simply don't cause problems (silent mutations). It's possible that Clark even has cancer or some other ailment, it just apparently isn't affecting his genes on such a scale that looking at a karyotype can discern it.

So what kind of destruction can cancer rain down upon your harmless little nuclei, the keepers of your genes? BAM!
This karyotype was taken from the cancer cell of a person with lung cancer. Look at all that! Who even knows where to begin?

My diagnosis (or Dx)? Not good things.
My treatment? Uh... Quit smoking.

Until next time.

Wait...What?!

Being paired with a local physician (preceptor) that we visit at least once a module makes up one of the clinical aspects of our first two years. It is with these preceptors that we have some of our aforementioned "patient contact." The experience generally lets us get more comfortable pretending to be doctors with being student physicians, but more than anything it helps reaffirm why we're all here. What do I mean by this?

As my preceptor and I sit in the side office of the clinic and he fills out the chart of a patient we just saw, the nurse walks in and hands me (as the real doctor is still busy) the next patient's chart. I glance down to see at what we'll be looking and my eyes go wide with surprise.

The Chief Complaint (i.e. the reason for coming) box reads:

Right Thumb- splinter under nail (noodle).

As one might imagine, I reread that sentence a few times. Curious, I look up at the nurse and she, trying to contain her surprise/amusement/disbelief, explains that he was cleaning some dried pasta from a pan and voila:

Noodle + Under + Thumbnail = Pain.

The real downside of this for the patient (It was great for me. I got to watch and help with something unusual.) is that pasta, being a grain product and rather moist, acts as a pretty poor tenant when leasing sub-cuticle space. After about 10 minutes of Lidocaine shots to numb the area (oddly enough the most painful experience for the guy), half of his nail cut off, and some nimble forceps work by my preceptor, he left likely feeling physically worse but thumbnail-infection/pasta free.

I am certain that while this is the first semi-strange experience in my medical career, it will not be the last. Until next time.

What Think You I Take My Pen In Hand?

The Gen/Neo module currently dominates my calendar and all its time enclosed. So, in order to escape from its tedium and rote memorization, this post will instead focus on everything not medicine related. Specifically...

Things I Like More Than Gen/Neo:

-Pouring just the right amount of granola into a cup of yogurt so that it doesn't spill over when I mix it.

-Being able to "hide" the annoying status updates (such as "Farmville" and "MafiaWars") on Facebook.

-The chill an autumn evening's air leaves in your chest.

-Feeling completely content wandering through a book store, even when not buying anything.

-The 3rd or 4th bite of a really good apple, once you've really broken through the skin and can get a crisp chunk of it.

-Getting an unexpected package, letter, magazine, or item in the mail.

-Jason Sudeikis on SNL.

-Opening the door to the mail box and seeing anything there.

-Top 10 (or 20/25/30/50/100) lists of just about anything, but particularly things to do with books or movies.

-The Sandman series by Neil Gaiman.

-Getting a really good Sporcle game when the "random" button is clicked.

-Hyperlinking.

-Writing with a really nice pen.

-Coming up with (what I think are) clever tags for blog posts.

-Freshly baked chocolate chip cookies.

-Having a wonderful wife (not at all because she will make a few extra said cookies when she's making them for work).

-All of the backgrounds and photos of InterfaceLift.

-Hitting a crosswalk at just the right time so that you don't have to break stride.

-Getting more than 6 good songs in a row on Pandora.

-The Office.

-Reading.

-Finding a good excuse to not study.



Until next time.

A Firm Declaration

Thankfully, I can now declare with absolute certainty that I have passed my first module of medical school. Do I know what my final grade will be? No. That can still change depending on how the retake test goes on Friday. (We take each test twice. Two exams, Same material. Highest score stays). But I do know that I will be continuing onward and that's a nice feeling to have. (Let me be real- I'd be continuing forward regardless, but I know that I won't be making up this module in the summer).

When I try to proverbially step back and examine my situation and what the module has been like, it's an interesting picture. Simultaneously it seems as though we've just started and yet been here forever. I can't believe we're already done with EIGHT WEEKS, but then again, it feels like we've covered 8 months worth of material. Who knows the best way to describe it? I sure don't.

The only thing I know is that this tricky thing called medical school is starting to feel more and more like normal for me, and I think that's a good thing. Will I feel this way in 2 weeks, when we're half way through our Genetics and Neoplasia (Gen/Neo) module? Probably not. In fact, I can almost guarantee you that I won't, but that's okay. I know that 2 weeks after that, post Gen/Neo and pre-I2 (Inflammation and Immunity), things will probably be alright.

Until next time.

Team Moral Victory?

The battle has been fought. The victors revealed.

For the women: The M1s reign supreme. Although the much-hyped M2 team (previously undefeated) fought hard (and by that I mean they were NOT happy about losing), the M1 Ladies pulled ahead and won by two touchdowns.

For the men: This is where Team Moral Victory comes into play. By and large, it was really a draw. Final score: 6-7, with the win going to the M2s.

Overall, I'd say we did pretty well for ourselves.

Am I Ready For Some Football?

One of the most rewarding aspects of my life as a medical student thus far (aside from the known wonders that are my wife, family and current friends) has to be the relationships and friendships that have begun to flourish. Proximity and shared evils (or struggles if you want a synonym) will inevitably cause the fellows of my class to bond and gain an understanding of one another that typically never develops in daily life. On top of even this, occasionally something will come along to unite a population to a new level. Such a circumstance has presented itself to us. That event?

Football.

A.k.a., the gridiron where the 1st year students (M1s) will boldly triumph over their second year oppressors (M2s).

In a few hours, the two classes will meet on the grass battlefield for two games of "flag" football: one men's game, one women's game. Throughout the day, via email and with the cunning use of YouTube videos, trash has been electronically talked and the School of Medicine now has 350 very rowdy and excited students on their hands.

While the outcome of the game technically remains unknown (come on, the M1s will dominate), the fun of anticipation has likely made it worthwhile for all those involved. Having this game to look forward to helps remind all the students that we can still have fun and not study every waking hour. Plus, a bunch of money is being raised for Harversters through ticket sales.

I leave you with one image and two links to better summarize the coming clash.

M2 Trash Talk

M1 Honesty

A taste of what's to come:
Until next time.

Health Care Reform: My Thoughts on "The Speech"

This evening (as most people know), President Obama addressed a joint session of Congress on Health Care, specifically:

• the current state of it in the U.S.
  
• his thoughts on why reform is needed
• what reform should accomplish
• what is/is not true about the rumors that have circulated about the proposed reform "bill."
  
  (I put "bill" in quotations because no official bill has yet been agreed upon. Four submitted, one more on the way)
  

A number of things stand out with this address, both in regard to his speech, and the nature of the event. While the President often addresses the nation, be it on prime time TV or otherwise, presidential speeches to joint sessions of Congress come few and far between. The last one given, to my knowledge (and excluding State of the Union/Inaugural Addresses), was given by President Bush after 9/11. I personally think this scarcity is because of how much time is spent applauding (if you're the party in power) and attempting to look as-defiant-as-one-can-while-sitting-during-a-joint-session-of-Congress (the minority party). The fact that Obama chose to hold such an address on health care stands as a testament its importance.

So, enough about the actual event, what about the speech? Overall, I found myself pleased with the speech. The President seemed to approach the entire debate head-on and systematically work through some problem issues. Could there have been more discussed? Of course. More details given? Without a doubt. From a practical stance, however, he seemed to cover the most important things as best as he could for the time being (it was only a 45 min speech, after all). I was specifically glad to hear Obama address the few following things (among many others, because my opinion obviously weighs heavily on both him and Congress):

• The current outrageous costs of health care when compared to nations similar to the U.S. Health care accounts for ~18% of our GDP , while the next closest country slides in at ~9% (That link is also just a good website to checkout for general health care facts).
  
  When compared, health rankings between the US and similar nations have no real statistical difference (measures include infant mortality, life span, cancer survival rates, etc). If there's no real different in that, and in patients' satisfaction with their physician, why does our cost so much more? For more information, this article summarizes things pretty well and pulls statistics from the CIA World Fact Book.
  
  
• The idea that an extreme change, to either the right (complete individual privatization) or the left (national single payer), can not be viewed as a feasible option right now. The health care system ties too tightly into the entirety of our economy and way-of-life that any major overhaul would simply be too detrimental .
  
  One of the most frustrating things to hear others talk about is how the US will have "socialized medicine." It's just not going to happen, and really, socialized medicine wouldn't actually be the end of the world (surprised, no?), we as a country just make terrible connections when we hear the world "Socialism" (You can thank the National Socialist German Workers Party for that, along with the Cold War. Oddly enough neither are true examples of socialism).
  
  I'm also glad he addressed other silly things like the idea of death panels and the fact that many in the GOP (and some on the left) are actively choosing to not work because it's a better political move. I'm sorry, I like to think that you were elected to work. I wish all in Congress would work so hard that there was no one the people could NOT reelect them rather than sitting-bored because you'd rather not make waves.
  
  
• His inclusion of Ted Kennedy's well-touted view that the health care debate should not be a political or partisan debate, but a moral debate. It's not often that I would prefer our Congress to debate moral issues, however the issue of health care strikes a different chord with me.
  
  I've always thought a person's ability to easily access adequate medical care when needed as something that just makes sense. I cannot understand why people are more than okay with protecting citizens and their safety by having military/police/firefighters/clean water/etc but then run scared when prompted to protect a persons general well being.
  
  It just does not compute for me. I think when people get sick they should be able to focus on getting well rather than even entertaining the idea that they might not go see the doctor because of access/cost.
  

I could go on for pages explaining all of my thoughts and comments about the speech and debate, but I'm not sure how many people have made it this far. If you really want to read more of my rambling ideas: click here.

If you missed the speech, NPR has a pretty good summary , or you can read the entire text here (it's a few clicks down, past an initial summary).

For a good website that just has interesting health care facts, check out the NCHC (National Coalition on Health Care- they were linked above too). I find the "Facts" tab at the top to be most interesting.

Sidenote: I wish my time stamp was accurate. Anyone know how to change that?

Lastly, what did you all think of the speech? Or how do you feel about the debate/reform? I'm happy to discuss or just see what other people think. Until next time.

The First Reprieve

This weekend has functioned as the first real "break" of my medical school career. The School of Medicine teaches its Basic Science years with a module plan. For 4/6/8 weeks, we students learn about a specific subject or system (such as Genetics or Inflammation and Immunity) and everything involved with it (such as Biochemistry, Cell Biology, etc) instead of having individual lectures over each traditional science subject. It seems as though the module system produces the same scores (if not higher) on board exams and presents the material in a manner that is more intuitive to the students being able to assimilate it with how it will be used in practice.

These modules culminate in a final exam (or a midterm and final for longer modules) that accounts for the overwhelming majority of a student's final grade. This results in a very cyclical life for students, as they go from feeling good at the beginning of a module to being increasingly more stressed until, as one lecturer stated, their eyes explode with stress right before the exam. Post-exam, assuming one's scores are passing (that's what we shoot for in med school. Not high grades, just passing), the system resets and we're not longer stressed.

This past week we had our first exam and the past few days have been wonderful. No longer do I view time as studying/should-be-studying, but I can view it as busy/FREE, if only for a few days.

So, in honor of the first exam being out of the way, I leave you with a few (humorous?) mnemonics that helped along the way:

Can I Keep Selling Sex For Money, Officer?
(Citric Acid Cycle Intermediates)

High Profile People Act Too Glamorous, Picture Posing Every Place.
(Enzymes of Glycolysis)

Val Raced Harry Through Walmart For MILK.
(Essential Amino Acid Abbreviations)

Until next time.

People Eating Tasty Animals?

Today was our second session of the clinical skills lab. These sessions could best be described as trying to teach us how to actually be a doctor. It is here that we learn and practice patient history, vital signs, heart/chest sounds, and all physical exam techniques. The students attend each lab in professional dress (with white coat and stethoscope) and see "patients," actors who have been trained in the proper techniques.

We are currently learning how to measure vitals. There are typically four main vital signs that physicians (or nurses or whoever is seeing you) check.

-Pulse (Heart Rate)
-Blood Pressure
-Temperature
-Respiratory Rate

These signs assess basic bodily function and serve as the first physical step in the clinical process of diagnosis. I say the first physical step of diagnosis as the patient history (as stated in my previous post) typically holds the crown for most important aspect of diagnosis.

Fun fact: while most everyone is familiar with how a doctor will assess your pulse (feeling the radial artery), take your temperature (a thermometer, be it tympanic or oral) and check your blood pressure (a sphygmomanometer and stethoscope), measuring respiration is typically done a little more covertly.

Think about it. Has your doctor every told you she/her is checking your respiration and watched you breathe? The likely answer?

Nope.

When someone knows their respiration is being counted, they inevitably think about breathing and thereby change their normal rate. Doctors typically hold the pulse longer than needed and count breathes or gently place a hand on your shoulder while doing so, allowing them to easily count the number of breaths while also measuring your heart rate.

Of course, a physician can always just watch a patient breathe while taking the history and count the number. Yet, (as one lecturer noted to the awkward laughter of the students) this can be a bit challenging when done on a female patient. Polite society dictates that eyes be up top and not down at chest level, especially during conversation.

Until next time.

A Good Word of Advice

Heard today, during our first session at practicing to be a doctor:

"The patient is the expert on the illness and disease. The doctor is the expert on how to fix it. Listen to the patient."

A Thought

As we sat in our first lecture of the day, and our first real lecture of actual "doctor" things (how to take a patient history), I could not help but be caught up by a point that was made. More specifically, a comment about a point. We were discussing why one should always strive to do a "patient-centered" history. It is exactly what the name implies. As much as an awkward student-doctor can, we are to encourage the patient to tell their story and naturally explain everything about their problem or situation. Among other things (such as being more effective and generally making everyone feel better), this has been proven to be a faster method of interviewing. The lecturer, who I've enjoyed and still do, followed up this point by stating that it was a "good thing." As a physician, it's better for me from a business standpoint to see six patients in an hour instead of four, and if a patient-centered interview can do that then why not?

But no one asked the question (although I don't think in the middle of an already-running-late lecture was the best place to do so anyway), "Is this really the best way to do things?" Should we, as the ones who allegedly "run" the field of health care, choose to base our habits and practices from a fiscal standpoint? Even if we include the fact of it being faster and therefore a better business practice among the variety of other reasons- some altruistic and for the better of the patient- for choosing to practice in this manner, won't the aspect of money and payment always be creeping in the back of our heads?

I know this- like so many other things- stems from a very naive and elementary point of view, but can I really say it would be better for me to shed my idealistic view completely and work with the way things are, never questioning?

The Swing of Things

We're halfway through the first real week and a routine already seems to be developing. The morning typically passes with three fifty-minute lectures that masquerade as simple and comforting. "Three hours a day? That's cake," one would seem to say. And it is...kind of...if you're willing to work. Each lecture consists of (depending on the lecturer) anywhere from 60-85 (sometimes 100+) slides that are jam-packed. If one focuses- and truly pays attention- the material is manageable- if there's also a commitment to reviewing/studying later that day. Thus far, I've been able to keep up and stay on top of things. I know and acknowledge that I am still blissfully ignorant of what things will be like when this continues for weeks/months/years, but for right now I call it manageable. It seems like this shouldn't be that unexpected, however, seeing as though the lore exists of school being hell, 175 random students manage to pass each year. The afternoons are filled with a variety of labs/small group/clinical skills sessions that (sometimes) remind all of us that there is that whole being-a-doctor note that this will end on.

An example week:
Fun fact for the day:
Some axons (namely the ones that run from the base of your spinal cord down your leg) can be up to a meter long. Good thing we've got those neurofilaments to hold 'em together.

Cloaked!

Today was the (symbolically) significant White Coat Ceremony. As we advanced nervously across the stage and accepted- through the donning of the white coat- the responsibilities and duties of a physician (as represented by the weight of the coat on our shoulders), an array of thoughts couldn't help but run through the minds of all of the now student-doctors.

Will I handle, with competence, the journey before me?
What will make me stumble?
How will I be challenged as a person and a healer?

And most importantly: How good do we all look in these coats, eh?!?!



Good lookin'!

First Thoughts

If you've been following along, I have no need to explain what today was. Overall, I'd say that the first day played out as expected, but that it's an interesting feeling to think about what it signifies. While I am truly no different than I was this morning or yesterday or two weeks ago (or really than I will be in another two weeks), there is a marked change in the potential to which I can- or am expected- to reach.

*Warning: the following will be a lot of my thoughts on the current state of health care. Read at your own risk*

The deans and higher-ups payed much attention to the status of the profession of medicine and how "we" operate/fit in society (I use 'we' to encompass the working members of the health care field- and don't worry, it still freaks me out to include myself in that definition). Not in the sense of a higher status than others, but in the sense of obligation and trust. Physicians- and all professionals (traditionally medicine, law and clergy)- operate out of the basic trust that society gives them. People surrender their sovereignty and judgment to doctors under the expectation that they work toward the greater good and only on the best interest of the patient. A doctor's power stems from this trust and if such a valuable thing isn't acknowledged and upheld it can (theoretically) be revoked.

The presentation made me think about the current issues of health care reform/insurance/cost/problems. Can we in the profession, by allowing it to get to the state it is in now, be held responsible for the current problems? Has the social contract been broken through the acceptance of a third party (being insurance/pharmaceuticals) in the patient-physician relationship? And if this is the case (which I believe it is), have we progressed so far that the power of the patient to revoke the social agreement has been made obsolete?

It's a big debate and a huge question. My thoughts will follow and don't worry, I know I'm mostly dreaming I believe we must (with all others- patient/administrator/insurance/pharmaceutical/government) be held accountable to the current problems and need to be instrumental in reform. Insurance companies need to stop focusing on charges and focus on costs. There's a huge difference between the two. Pharmaceutical companies need to quit worrying about patents and shift from a business-focus to a public-good-focus through providing affordable drugs. Patients need to accept the fact that the system isn't perfect, cannot be ruled by the market alone and that they cannot always get everything they want. The system exists with a finite number of resources and (I know this is shocking to hear) some rationing and restrictions must be made. From a med school/student view, I honestly think there needs to be restrictions on specialties and residency programs. There's an astounding shortage of primary care doctors, and too many people need a dedicated and gate-keeping primary care doctor to focus on preventative and consistent care to keep churning out the wonky ratio of primary care/specialist docs that we are now (32%/68%- and that's being generous. Read here). It's a nasty thing to hear (particularly from a med student perspective) and I don't know if it'll ever happen. Just like patients being regulated to specific doctors, med students don't like to have their choices restricted. It goes against the ingrained nature of the American ideal: freedom of the individual.

*End of thoughts of current state of health care*

Wow. If you read all that, bravo. I commend you. If anyone has any questions or wants a discussion, I'm all for it. If you want to really get a good look at this, read The Social Transformation of American Medicine by Paul Starr. It'll rock your world. As for the actual happenings of the day, we got a sweet computer (which I'm currently posting from) and found out some (kind-of) interesting information about student services (health center/rec/study options/etc).

In closing, so that everyone knows exactly where I stand on the health care ladder, I can be referred to (and should call myself) a student-doctor. I feel like some kind of awkward teenage of medicine. Also, there's no way that I'm the only one who thinks the phrase "patient-contact" (used to note situations where we'll encounter patients) conjures images of discovering a new alien species.

Dean: Everyone dress business casual tomorrow, as we'll be having patient-contact on the trip to Wichita.
Student: Should we expect hostiles or friendlies, sir? Do they look human in nature?

Too Accurate

I was going to write a legitimate post. Was. I read this and proceeded to laugh so hard that now I can't do it. Most people probably won't see the same hilarity I do, likely because they- unlike me- are not wholly represented by the man in the comic.

Until next time.

(Orientation tomorrow!)

Lest I Forget

Things to remember (or be reminded of):
I chose to be a doctor and want to learn medicine. For all of the debt, time-sucks, struggles and stresses I will face as a med student, let me remember that I chose this path and for good reason. While I might get fed up with the hours, the tediousness, the paperwork, the emotions, the unruly patients, the failure, the system/bureaucracy, and the general downside of it all, let me use that frustration to highlight the immense potential for good this profession will allow me. I do not know exactly what I am getting myself into, but let me accept and experience it all together; appreciate it all; use it all.

Never think yourself better or more deserving than another.

Everyone deserves care (there's a reason you like the idea of a SP Universal system).

Be humble and intelligent enough to say, "I don't know."

Never discount the small victories or joy taken from something, even if others find it insignificant.

Always strive to learn more, be it from a class, a patient, a colleague, or a mistake.

Things to remember from someone who knows more than me and has done it for years:
-Keep your head on straight.
-You have the tools.
-Don't be dazzled by bullshit.
-Separate facts from fiction and "conventional advice."
-Make sure all things pass the smell test for veracity, virtue, and truth.
-Have fun.


Now, in an ideal world, I'd never even have to look at this post because I will be so perfect in school and never doubt myself and things will be peachy and never difficult or rough and life will be fantastic and the sky will be made of Jello (and stop global warming, duh) and the ground of marshmallows and gummy bears and no one would get diabetes from living in a land of sugar.

I don't think so.

D-Day Minus Seven

Today marks the beginning of the end for me.

Actually, that's not true. That's just melodrama. In one week, I will begin orientation for medical school. I am nervous, yes, but I am also really excited and worried and giddy and any other number of emotions. The spectrum of feelings comes from the unknown nature of what's to come. In a literal sense, I understand the entity of med school. I know that I'll have classes/tests/labs/etc and that I'll likely do just fine. I know people who are doing it now and who have finished. It is possible. Will it be a challenge (and by challenge I mean the hardest thing I've ever done)? Of course. But, I don't know (and I don't think you can know until you experience it) how I will handle life as a med student and the changes to myself and my life that come along with it.

Will my view of health care and what it should be in society change? My opinions and outlook concerning ethics and the obligations of others? There are big questions involved in starting something like this, or at least I imagine there to be. And lest we forget the other questions that inevitably arise: What will gross me out the most? Will I ever get used to the idea of people turning to me, the guy who builds fictional wooden cubes for fun and still routinely reads Calvin and Hobbes, for answers in huge life decisions?

I suppose more than anything, even with these questions and concerns, I'm still just really excited to start. I can only liken it to the first day of school, be it kindergarten or college. Right now the unknown still triumphs (although I suspect it always will) and I love the potential that exists. The thought of the amount of information I will learn (which will be but a fraction of what they teach) excites me and I think I'm as ready now as I'll ever be to begin.

But don't let me get ahead of myself. It's really the beginning of the beginning. I still have 7 days of freedom. I'm going to go read, play Xbox and make some chicken stir fry for dinner when my better half gets home. After I fold the laundry.

A New Test

People often assume, upon hearing that I'm going to med school, that I majored in the sciences "or something like that." I've been met with looks ranging from surprised pleasure to confused disdain after telling them that I did, in fact, major in English.

This blog stems out of that fact.

I majored in English, and while I start medical school soon (read: in approximately 1 week) I fear that my major will be, as so many people have said, irrelevant. While the specific focus/major of a person attending med school doesn't matter (only that they've completed the necessary pre-reqs), I don't want my English degree to be meaningless. As most people who know me can attest, I love to read. Perhaps to a level of obsession. I also love to write and just seem to love the English language in general. I don't want this passion/obsession to fall by the wayside while I plunge (or drown) headfirst into the murky sea of medicine. (Ignore the fact that the above explanation implies something falling...by the wayside...of a sea...that people swim in?)

The point is:

I want to write and think about language. To not lose what I've given so much time to thus far. So, I will attempt (for now) to chronicle my thoughts and experiences as a medical student here. I cannot promise you anything except that this blog will inevitably contain some pretty strange writings, and I assure you that my holding an English degree does not mean I will write well. Enjoy.